Cleveland Clinic trustees tighten ethics policies

By THOMAS J. SHEERAN, Associated Press Writer

CLEVELAND (AP) - Cleveland Clinic trustees have moved to ensure patients will be aware of possible ethical conflicts involving doctors, trustees and the growing business ventures of the research hospital.

The changes come after a hospital review found shortcomings involving ethical conflict disclosures have occurred across the board at the clinic.

In December, a Wall Street Journal story detailed clinic CEO Dr. Toby Cosgrove's relationship with a medical-device company and the clinic's role in a venture capital firm that invested in it.

Cosgrove sat on the company's board of directors and served as a general partner of the venture firm.

The policy change, approved by the board Monday and announced late Tuesday, creates a regular standing trustee board committee on ethics matters. The head of the committee will meet regularly with the top staff officer checking for conflicts between patient care and profits.

In addition, trustees approved upgrades in a database to make the 1,500 doctors and others working at the hospital and its satellite operations aware of possible conflicts involving trustees or clinic-related business ventures.

The policy would require disclosure and competitive bidding if the business of an outside trustee is trying to sell to the clinic.

The board began tightening conflict of interest policies governing physicians last year, including a limit on outside consulting fees.

The clinic released summaries but didn't release the revised policy documents.

Dan W. Brock, a professor of medical ethics at Harvard University, said he had no data on how many hospitals require disclosure of conflicts involving trustees.

"It wouldn't surprise me that the Cleveland Clinic is a little ahead on this. They have been facing these issues recently in a fairly public way," he said.

Tiffany Himmelreich, a spokeswoman with the Ohio Hospital Association, said the government requires nonprofit hospitals to have conflict of interest policies to make sure the institution operates in the best interest of the community. The clinic's research work puts it at risk of more conflicts than many hospitals might see, she said.

Board members said the revised policy would ensure openness.

"The issue has to be transparency and disclosure on a continual basis," said William MacDonald III, a clinic trustee.

MacDonald, vice chairman of Cleveland's National City Corp. banking company, said the board found no evidence that the clinic's reputation had been damaged by ethical lapses.

"We can't find evidence that it had any negative impact at all whether fundraising, whether patient activities, patients coming to the clinic. Operating results are strong. We just haven't seen it," he said.

That might be because "we did try to be responsive to what we've heard. We formed this committee. Doctor Cosgrove came out very early and said he wanted a full trustee review," MacDonald said.

The law firm that reviewed ethics oversight at the clinic, McDermott Will & Emery of Chicago, said actions taken by trustees in response to the outside audit were consistent with the board's goal of creating the best possible approach to ethics matters.

The clinic plans a national symposium Sept. 20 on medical conflicts of interest. "This is an area of uncertainty for all academic medical centers, and all institutions are struggling to strike the right balance," the clinic said.

(Copyright 2006 by The Associated Press. All Rights Reserved.)